Facilitating Mental Imagery to Improve Mobility After Stroke: All in the Head

In this issue of Neurology®, Mihara et al.1 suggest that facilitating plasticity of noninfarcted nodes of the motor network using functional near-infrared spectroscopy–mediated neurofeedback (fNIRS-NFB) may improve aspects of gait and balance after stroke. NIRS signals detect changes in oxygenated blood flow to areas of neural activity (e.g., contralateral primary motor cortex, bilateral supplementary motor areas [SMAs], and cerebellum) on tasks such as walking and foot flexion or extension. These signals can be fed back to patients to try to upregulate their cortical activity when performing mental imagery. Mental imagery of motor tasks produces cortical activation patterns similar to actual practice and has been used to facilitate gains for the arm/hand with modest success.2

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